All About Treating SIBO with Herbal Antibiotics

What are herbal antibiotics?

Antibiotics kill bacteria. We mostly think about antibiotics as pharmaceutical pills that a doctor prescribes us. But many herbs have antibiotic properties too, and can be successfully used for treating SIBO.

If you want to know which herbal antibiotics to use for SIBO, and how to take them, then this guide will give you all the info you need!

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Is treating SIBO with herbal antibiotics better than treating with pharmaceutical antibiotics?

In my opinion, treating SIBO with herbal antibiotics or pharmaceutical antibiotics are both legitimate, effective options.

Benefits of Treating SIBO with Pharmaceutical Antibiotics

The benefits of pharmaceutical antibiotics include that they have been rigorously studied and tested for safety and effectiveness. Rifaximin, for example, specifically targets the small intestine and has been shown to only minimally impact the microbiome of the large intestine.

When you take pharmaceutical antibiotics, you generally have a good idea of the common side effects. Plus, if your insurance covers pharmaceutical antibiotics, it may be cheaper than shelling out money for over the counter herbal ones.

Drawbacks of Treating SIBO with Pharmaceutical Antibiotics

The drawbacks of pharmaceutical antibiotics are that many people think that pharmaceutical antibiotics are harder to tolerate, with more side effects, than herbal ones. However, I’m not aware of any actual data confirming that. It also depends on the antibiotics being used, of course. Some antibiotics are systemic, meaning they will impact all your gut bacteria. Others, like Rifaximin, are more selective about which part of the intestine or bacteria they target.

Depending on your insurance, pharmaceutical antibiotics may be more expensive or not covered at all. Rifaximin, the most common antibiotic used to treat SIBO, can be over $2,000 if your insurance doesn’t cover it!

In my case, I had to get pre-authorization for Rifaximin, which took several weeks to get approved. The pharmacy billed my health insurance over $2,000 for Rifaximin, but thankfully my health insurance covered the entire cost. If I had to pay for it myself, then treating SIBO with herbal antibiotics would have been significantly cheaper.

Benefits of Treating SIBO with Herbal Antibiotics

The benefits of herbal antibiotics are that many people report having less side effects than pharmaceutical antibiotics. Again, I haven’t been able to find any actual studies comparing the side effects.

Many people consider herbal antibiotics superior because they are “natural”—only you can determine whether that is important to you or not.

One great advantage of herbal antibiotics is that they don’t run as high a risk as of antibiotic resistance. Antibiotic resistance happens when bacteria are repeatedly exposed to the same antibiotics and begin to resist survive the treatment more readily, making the antibiotics less effective. This doesn’t happen as often with herbal antibiotics so you can use them repeatedly without worrying about antibiotic resistance.

Finally, and I think most importantly, many people cannot find or afford a doctor that knows much about SIBO. Many doctors want you to take antibiotics that have not been shown effective for SIBO. And that’s assuming your doctor is even aware of SIBO in the first place!

In these cases, you may need to take your health into your own hands and make the best decision for yourself. That might include treating your SIBO with herbal antibiotics, which you can get over the counter and relatively cheaply. Certain combinations of herbs have been proven in a clinical study by Johns Hopkins to be as effective as Rifaximin for treating SIBO. I explain which combinations later in this post, so keep reading!

Drawbacks of Treating SIBO with Herbal Antibiotics

The drawbacks of treating SIBO with herbal antibiotics are that it takes a lot longer, usually four weeks, to complete a course of treatment. So if you have side effects, they will last longer.

Furthermore, herbal antibiotics are systemic. That means the herbs will affect both the bacteria in your small and large intestine. So unlike Rifaximin, which only really affects the small intestine where SIBO occurs, your entire gut microbiome will change when treating SIBO with herbal antibiotics. Whether that helps or hurts probably just depends on your individual case.

Of course, none of these treatments work for every person, and each person will have different experiences and reactions. Do you ever feel like having SIBO is kind of like being a guinea pig used for science experiments? I sure do…

What herbal antibiotics are used for treating SIBO?

Garlic yes…you heard that right! Garlic’s antibiotic properties have been used by people for hundreds of years. Not only does it work as a natural antibiotic but it has antiviral and antifungal properties too. And as a plus, it distrupts biofilms, which some sources suggest may help defeat SIBO (although the jury is out on how important biofilms are). Garlic also helps to prevent antibiotic resistance from forming.

Allicin is the compound in garlic that gives it most of these properties. Unfortunately, Allicin is highly unstable and begins to degrade as soon as the garlic is cut, crushed, or chewed.

Because Allicin is so easily damaged, if you’re using garlic, for SIBO you will see that it’s highly recommended to only use a brand called Allimed. Allimed is the only garlic supplement which contains stabilized Allicin, and it’s the most potent garlic supplement available.  With Allimed, the Allicin has been stabilized to maintain its beneficial properties to their full potential. Allimed is what almost all natural practitioners recommend for a garlic supplement, including Allison Siebecker who is probably the most well-known SIBO naturopath.

Allimed should be taken in doses of 1,350- 2,700 mg per day, divided into 3 doses throughout the day, if taken as the only herb being used at the time. According to Dr. Siebecker, Allimed is particularly good for treating methane, constipation-type SIBO.

You can get Allimed here. I suggest buying it straight from the manufacturer because some customers on Amazon have left reviews saying that they didn’t receive the correct product when ordering off Amazon. Don’t take chances!

And a final note, garlic itself contains fructans (a FODMAP) which will aggravate SIBO. Fortunately, Allimed does not, so you don’t have to worry about FODMAPs with it.

Neem comes from the fruits and seeds of the Neem tree and has long been used for its antibiotic properties. It also has antifungal properties, and may have antiviral properties. A word of warning though—Neem oil may have contraceptive properties, so if you’re pregnant or trying to become pregnant, skip this one.

Dr. Siebecker recommends 900 – 1.800 mg per day, divided into 3 doses. You can find Neem on Amazon.

Oregano is part of the same family as mint. The active compound in Oregano oil, carvacrol, gives it antibacterial, antiviral and antifungal properties. Oregano can treat heartburn, parasites, and more.

However, Oregano oil does have a tendency to irritate mucous membranes. Dr. Siebecker suggests using emulsified Oregano oil because it may help avoid this effect.

Dr. Siebecker recommends a dose of 450 – 600 mg per day, divided into 3 doses. You can find high quality, microemulsified sustained released Oregano oil on Amazon.

Berberine is not an herb itself, but a compound found in a number of herbs such as Goldenseal, Barberry, Oregon grape, and others. In addition to antimicrobial properties, Berberine also helps fight inflammation and lower blood glucose levels. Berberine was one of the herbs included in one of the studies showing that treating SIBO with herbal antibiotics works.

Berberine is supposed to be very effective against hydrogen-producing bacteria. It’s commonly paired with Neem and Oregano for people overproducing only hydrogen. For hydrogen and methane producers, pair Berberine with Allicin and

Dr. Siebecker recommends a dosage of 5,000 mg per day, divided into three doses. You can find it on Amazon. 

Peppermint oil has an anti-microbial effect. In addition, peppermint works as a digestive aid and helps with bloating, gas, and other IBS, SIBO, and digestive complaints. In one case study examining the effect of enteric-coated peppermint oil taken by a single SIBO patient, the patient experienced improvement with symptoms, and decreased hydrogen gas production. This suggests peppermint oil may be helpful for hydrogen-predominate SIBO (which usually causes diarrhea).

Look for one that is a high dosage, 200 or more mg, contains an enteric coating to make sure that it is intact by the time it gets through your stomach, otherwise you could get heartburn or a burning minty sensation. I like this brand which contains 250mg of peppermint oil in an enteric coating.

Herbal Blends:

The only two clinical studies I’m aware of that successfully demonstrated what herbs to treat SIBO with used several products made up of blends of different herbs.

The first study used Dysbiocide and FC Cidal, made by a company called Biotics Research.

Dysbiocide is a blend of nine herbs and extracts, and the company recommends taking two capsules twice a day for a total of four capsules a day.  FC Cidal is a blend of seven herbs and extracts. Take doses of two capsules twice a day.

The study that compared this combination and found it as effective as Rifaximin had patients take the combination for four weeks. Amazon carries both Dysbiocide and FC Cidal.

The other study used Candibactin-AR and Candibactin-BR, made by a company called Metagenics. These herbs also fight against yeast and include the herbs Sage, Oregano, and Thyme. You can find Candibactin-AR and Candibactin-BR on Amazon.

Which herbs should I take, and in what combination?

Ultimately, you may want to consult a naturopath or other practitioner for this question.

Dr. Siebecker recommends either taking a combination of two to three herbs. She suggests a combination of Berberine, Neem, and Oregano if you have hydrogen-dominant SIBO (diarrhea predominate SIBO).

For methane-dominate SIBO (constipation predominate SIBO), she recommends a combination of Neem, Garlic, and Oregano. 

For both hydrogen and methane, try Garlic, Berberine, and Neem, or Garlic and Oregano.

But, it all depends on your symptoms and what you tolerate. For example, if you have bloating and hydrogen, you may want to try adding peppermint to the combination you take.

How long should I take herbal antibiotics for? 

A course of 30 to 60 days of an herbal protocol is typical. But I’ve seen people who took them for two weeks and saw improvement as well.

Do know that the die-off effect of bacteria happens over a longer course of time with herbal antibiotics than with pharmaceutical ones, so you may feel unwell or possibly worse for a while.

Keep in mind that for many people, one course of treatment isn’t enough to eradicate SIBO. This is true whether you’re taking pharmaceutical antibiotics or herbal ones.

And some final words of advice…

Whether treating SIBO with herbal antibiotics or pharmaceutical ones, keep an open mind about trying new treatments! You may have to try several courses of treatment, whether with the same drugs or different ones. But know that improvement IS possible and don’t give up!

Learn about how I treated my SIBO here.

Have you used herbal antibiotics before? How did they work for you?